Transcranial Magnetic Stimulation (TMS) Plus Modified Constraint-Induced Aphasia Therapy (mCIAT): A Pilot Feasibility...

Background/Objectives: Stroke-related aphasia significantly impairs communication and quality of life (QoL). Constraint-induced aphasia therapy (CIAT) and repetitive transcranial magnetic stimulation (rTMS) are evidence-based approaches targeting language recovery. No combined protocol exists for Greek, a morphologically complex language. The present study was designed as a feasibility pilot, with the primary objective of determining if a modified CIAT (mCIAT) protocol, with or without continuous theta burst stimulation (cTBS), could be delivered safely and acceptably in a Cypriot clinical context, while also reporting the first mCIAT protocol adapted for Greek. Methods: A single-subject experimental design (SSED) was employed. Two participants (PAs) with chronic anomic aphasia underwent a 10-day treatment protocol. PA1 received sham cTBS plus mCIAT-GR; PA2 received real cTBS (to the right inferior frontal gyrus) plus mCIAT. Multiple language, cognitive, and QoL measures were administered across three baselines and two follow-up time points. Results: Both PAs completed the full protocol with 100% session adherence and no adverse effects, establishing the feasibility of delivery. Neither participant showed improvements in standardized expressive language measures following mCIAT with or without cTBS; Standard Error of Measurement (SEM) analysis confirmed that observed score fluctuations on most measures fell within expected measurement noise. PA2 showed improvement in QoL (SAQOL-39g) domains at the two-year follow-up, though this finding requires cautious interpretation given the follow-up interval and regression-to-mean considerations. Conclusions: The Greek mCIAT protocol is feasible and safe to deliver in a Cypriot clinical setting. The absence of clear language improvements may reflect several factors, including ceiling effects, limited assessment sensitivity, insufficient treatment dosage, or limited intervention effects. These findings should be interpreted cautiously and require confirmation in larger, adequately powered studies.